En ungdom med luftveisplager og kortvarig feber

Abstract

Choice of treatment can be challenging in the casualty clinic. Early in the disease course in particular, clinical signs can be sparse and diagnostic tools limited. Sometimes the road to ruin is paved with good intentions. Symptoms of a respiratory tract infection are among the most common reasons for attendance at GP surgeries and casualty clinics. In the current case, a viral upper respiratory tract infection is a likely diagnosis, while infection-triggered obstructive pulmonary disease, pneumonia and influenza are possible differential diagnoses. It was not influenza season, but there was an ongoing mycoplasma epidemic. Symptoms of atypical pneumonia are a long-lasting severe dry cough, sore throat and headache, but the patient had neither a cough nor a sore throat. A boy in his earlyRarer differential diagnoses were considered unlikely. He had a low risk of pulmonary embolism and no stabbing pains upon inspiration. The absence of pain also made pneumothorax and pleuritis unlikely. In addition, he had similar respiratory sounds on both sides. With tuberculosis we would have expected a cough, which he did not have. He had no heart problems and there was no suspicion of heart failure. Bronchitis and pneumonia are frequent causes of shortness of breath. Bronchitis is chiefly attributable to viruses, while pneumonia in adults is usually caused by bacteria. The most common agents outside hospitals are Streptococcus pneumoniae, followed by Chlamydophila pneumoniae and viruses, as well as M. pneumoniae during epidemics every few years. In children over three months, the aetiology is reversed, with viruses the most common agents. Bacteria are the main cause in the very young.